Long-term effects may create significant problems, as they can cause lasting damage to the body and affect the person's quality of life. These effects, which are often cumulative, include physical effects, second primary malignancies, and sexuality and psychological issues. Specific effects include:1
- skin reactions
- nail ridging
- organ damage, e.g. renal, hepatic, pulmonary and cardiac
- neurological problems and CNS toxicity
- sexual dysfunction
- psychological issues.
- Fatigue may be related to the disease and/or treatment effects such as pain, nutritional problems, and myelosuppression.
- Associated with feelings of tiredness, lack of energy and inability to continue, fatigue has been suggested to affect 60-90% of individuals receiving antineoplastic agents.1
- Fatigue. Putting Evidence into Practice (PEP) resource, Oncology Nursing Society.
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Cancer-Related Fatigue
- These include taste changes, pain from mucositis, nausea and vomiting, and reduced hunger sensations.1
- Self-Care Strategies to Cope With Taste Changes After Chemotherapy39
- National Cancer Institute: Nutrition in Cancer Care40: This PDQ cancer information summary provides comprehensive, peer-reviewed information for health professionals about nutrition before, during, and after cancer treatment.
- Peripheral neuropathy induced by antineoplastic agents impacts on physical functioning and quality of life.
- Antineoplastic agents associated with peripheral neuropathy include platinum compounds, taxanes, vinca alkaloids, thalidomide, and bortezomib.41
- Peripheral Neuropathy. Putting Evidence into Practice (PEP) resource, Oncology Nursing Society.
- Hair loss may be apparent 1-2 weeks after administration of antineoplastic agents and reaches a peak in 1-2 months.
- Agents associated with hair loss include: amsacrine, bleomycin, busulfan, cyclophosphamide, cytarabine, dactinomycin, daunorubicin, dacarbazine, doxorubicin, etoposide, 5-FU, hydroxyurea, ifosfamide, interleukin-2, methotrexate, nitrosureas, procarbazine, vinblastine, and vincristine.
- Distress and anxiety related to altered body image and self-concept may occur.1
Sexual and reproductive issues
- Women may experience amenorrhoea with hot flushes, insomnia, and vaginal dryness as well as decreased fertility or permanent infertility.
- Actual and potential gonadotoxic agents include nitrogen mustard, cyclophoshamide, L-phenalalanine mustard, busulfan, and chlorambucil.1
- Men may experience decreased or absent production of sperm, which may recover over a period of years.
- Sperm production is affected by alkylating agents, cisplatin, vinblastine, and bleomycin1.
- National Cancer Institute Sexuality and Reproductive Issues (PDQ®) This PDQ cancer information summary provides comprehensive, peer-reviewed information for health professionals about sexuality and reproductive issues that cancer patients may experience during or after treatment.
- The psychosexual care of women affected by gynaecological cancers42: These learning modules will help all health professionals develop the knowledge and skills to support women and their partners experiencing psychosexual concerns following gynaecological cancer. This resource can be used for self-directed learning or by educators in both clinical and academic settings as part of a facilitated learning program.
- Cardiotoxicities may develop as intermediate to late effects after treatment with antineoplastic agents.
- Agents associated with cardiotoxic effects include doxorubicin, epirubicin, mitoxantrone, idarubicin, trastuzumab, bleomycin, high dose cyclophosphamide, 5-FU, ifosfamide, mitomycin-C, and paclitaxel.1
- Pulmonary toxicities occur due to damage to the endothelial cells of the lungs, and result in pneumonitis or fibrosis.
- Agents associated with pulmonary effects include bleomycin, BCNU and CCNU, busulfan, carmustine, chlorambucil, cyclophosphamide, cytarabine, docetaxel, fludarabine, lomustine, melphalan, methotrexate, mitomycin C, and paclitaxel.1
Second primary malignancies
- Secondary malignancies can be categorised as treatment-related, syndromic, or due to shared etiologic influences (lifestyle, environment, individual factors or genetic or other influences).43
- Secondary malignancies are most commonly related to the use of alkylating agents, the duration of therapy and the use of antineoplastic agents in people aged over 40.43
- The most common antineoplastic agent induced second malignancy is acute leukaemia. Second cancers have distinctive chromosome abnormalities, and survival after antineoplastic agent-related leukaemia is generally quite poor. Non-Hodgkin's lymphomas or solid tumours also can occur as second malignancies.43
Choose three long-term effects of antineoplastic agents, and summarise current evidence based strategies to prevent and manage these effects.